The ANSC GP Resource Manual is no longer available as a program resource. All clinical information and advice, can now be viewed on relevant Sydney HealthPathways or resources on this site.

Revision of antenatal visit schedule: In response to COVID-19 (20 April)

RPA Women and Babies and Canterbury Hospital have revised the antenatal schedule of visits to adapt to COVID-19

Please review the following documents as guidance for antenatal care during this time. 

• Click  pdf here (80 KB)  for cover letter from Clinical Prof Jon Hyett - Head of High Risk Obstetrics, RPA Women and Babies
• Click  pdf here  (71 KB) for revised antenatal schedule of visits (updated 14 April : Noted to include routine 26-28 week GTT, pertussis vaccination b/n 20-32 weeks) 
• Click here for video teleconference with Prof Jon Hyett : Antenatal care during COVID -19  RPA Women and Babies/Canterbury  

These recommendations are for women attending both RPA Women and Babies and Canterbury Hospital for their antenatal care.

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GPs participating in the ANSC program will be expected to adhere to the agreed guidelines as outlined in the SLHD ANSC Protocol when caring for their antenatal shared care patients.

 

 SLHD Antenatal Shared Care Protocol - Antenatal Clinic  (September 2018) 

 SLHD Antenatal Shared Care Protocol - Birth Centre  (September 2018) 

Breaches of the ANSC Protocol that affect patient outcomes will be recorded for quality assurance purposes. Any investigations requested by the GP for a woman under his/her care must be followed up by the GP concerned. At all times it is the primary responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up management and communication, irrespective of whether a copy has been sent to the participating hospital

pdf Pregnancy Checklist (182 KB)  - Patient Resource.  A pregnancy checklist that suggests topics your patients should discuss with their GP/ health professional during your pregnancy and following birth.

Click pdf here (282 KB) for service update in response to COVID-19

The aim of EPAS is to identify and manage ectopic pregnancies, vaginal bleeding in pregnancy, or miscarriage less than 20 weeks gestation. The service is available to assist you with the management of your haemodynamically stable patient.

If patient is clinical unstable and less than 20 weeks pregancy, arrange immediate transfer to relevant hospital Emergency Department  

Urgent review for pregnant patients < 20 weeks gestation, contact relevant hospital on-call Gynaecology Registrar
Contact relevant hospital on-call O&G Registrar for all pregnant patients > 20 weeks gestation.These women should be sent to hospital Delivery Ward 

Referral criteria

Patient must:

• be less than 20 weeks pregnant,and
• have abdominal pain or vaginal bleeding,and
• be experiencing only mild to moderate symptoms,

                 or

• have an incomplete miscarriage or threatened miscarriage, confirmed by ultrasound

Women attending Canterbury Hospital who fulfill referral criteria (and willing to travel) may be referred to EPAS at RPAH or St George Hospital 

Exclusion criteria

• Patient more than 20 weeks pregnant – ph. Obstetric Registrar (02) 9515‑6111 for management  in the Delivery Ward.
• Termination of pregnancy
• Dating scans
• Management of hyperemesis

Referral advice 

For advice or guidance regarding patient referral, please contact Clinical Midwifery Consultant (CMC) Mon - Sun  08.00am-4.00pm  Ph: 0429 728 608  Fax 9515 3454 (Health Professionals ONLY). There is no need to contact CMC for all EPAS referrals, only if further referral advice is required.

 For all other non early pregnancy/gynaecological issues, please contact hospital O&G Registrar ph. 9515 6111.

Required information

• Pathology copy of blood group result
• Most recent serum quantitative BHCG where available
• Any previous ultrasound results
• Significant medical history
• RPAH Fetal Medicine ultrasound referral form
• Complete EPAS Referral Form and give to patient to take to clinic  

Inform the patient 

• Must present to the Women’s Ambulatory Care Reception (Level 5) at 7.30 am (Mon- Fri) the next business day. 
  There are no appointment times and waiting times will vary.
• Preparation requirements – a full bladder is not required and fasting from midnight is preferable.
• If the patient consents, a report will be mailed to the general practitioner on the day of consultation.
   Patient Brochure -  pdf RPA  (283 KB) pdf Early bleeding in pregnancy (283 KB)

Fetal movements are a reliable indicator of fetal well-being. Any maternal reporting of a change in fetal movements should be taken seriously and assessment arranged as soon as possible.

 RPA Women and Babies - pdf Decreased fetal movements guidelines  (117 KB)
 Movements matter - comprehensive suite of resources for both health professionals and consumers developed by the Centre of Research Excellence in Stillbirth. Translated information also available 
 Safer Baby Bundle- online learning module developed by the Centre of Research Excellence in Stillbirth covering 5 elements : Smoking Cessation, Fetal Growth Restriction (FGR), Decreased Fetal Movements (DFM), Side Sleeping and Timing of Birth.
 Safer Baby Bundle Handbook and Resource Guide - Handbook developed by the Centre of Research Excellence in Stillbirth covering 5 elements : Smoking Cessation, Fetal Growth Restriction (FGR), Decreased Fetal Movements (DFM), Side Sleeping and Timing of Birth.
 Maternity - Decreased Fetal movements in third trimester - NSW Health Guidelines

  pdf Diagnostic Process for Hyperglycaemia in pregnancy (504 KB)  - resource which includes defining risk, screening protocol, interpreting results, postnatal follow-up and pre-pregnancy assessment
  pdf Glucose Tolerance Test (GTT) Instructions (149 KB)  - patient instruction for GTT testing
 ADIPS - Australian Diabetes In Pregnancy Society- Resources for both health professionals and patients

Early identification of women experiencing psychosocial problems and mental health conditions in the perinatal period it important so they can recieve timely support and care. 

  pdf Mental Health Care in the Perinatal Period - Australian Clinical Practice Guideline (681 KB)  - Centre of Perinatal Excellence (COPE)
 COPE Centre for Perinatal excellence - provides resources for both health professionals and consumers
 Screening and assessment tools : Including psychosocial risk assessment (ANRQ/PNRQ) , assessment of depression and anxiety (EPDS. Includes D&A and D&FV questions , assessing mother and child interaction
  pdf Looking after your perinatal mental health (611 KB)  - Information for patients
 beyondblue - provides access to a variety of information regarding perinatal mental health

Clinical Services
Psychological Support Services (PSS)

PSS provides FREE short term face-to-face psychological services to people living in the CESPHN region. Priority groups include women experiencing perinatal depression from conception to 12 months after birth.

For more information visit our PSS page

St John of God Medical Centre 
Free Medicare fund Psychiatrist service for women in the perinatal period that cannot afford a consult with a private psychiatrist.
The clinic provides short term assessment, therapy, and treatment plan and the woman is referred back to the GP for ongoing management

For more information and referral processes visit pdf Clinic Information (476 KB) and pdf GP Referral Form  (261 KB)

All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.

Antenatal Shared Care GPs can refer women directly to the Fetal Medicine Unit (Phone: 9515 6042) for the following tests:

• Combined First Trimester Screening (cFTS)
• Non-Invasive Prenatal Screening (NIPT)
• Chorionic Villus Sampling (CVS)
• Aminocentesis

A pdf referral form (298 KB)  is required to be completed for referral for these tests. Women should contact FMU to arrange appointment Ph: 9515 6042. GPs can contact service i.e follow-up results etc via email SLHD-RPAHFetalMedicineUltrasound@health.nsw.gov.au 

Timing of procedures 

Procedure	Gestation (wks)
Non- Invasive Prenatal Testing (NIPT)	10 weeks onwards
Combined First Trimester Screening (cFTS)	11+1-13+6
Chorionic Villus Sampling (CVS)	11-13
Amniocentesis	15-19

The Fetal Medicine Unit (FMU) at RPA Women and Babies routinely offers Combined First Trimester Screening (cFTS): ultrasound scan (nuchal translucency and nasal bone) plus biochemistry to pregnant women booking for delivery at RPA Women and Babies and Canterbury Hospitals 

Referral for cFTS: 

• Complete   pdf FMU Ultrasound Referral Form  (298 KB)
• Complete pdf RPAH First Trimester Screening Pathology Form (157 KB) - advise woman that blood can be collected from 11 weeks until at least 3 days prior  to ultrasound appointment. It should be collected at either RPAH or Canterbury Hospital Pathology Department 
• Provide woman the   pdf First Trimester Screening Patient Information Sheet  (127 KB) which outlines screening test procedure
• Provide relevant Patient Information Brochures     pdf cFTS  (285 KB)      pdf NIPT (537 KB)   pdf CVS & Amniocentesis (358 KB)
• Advise woman that her results will be available at time of U/S appointment (ensuring that blood has been collected prior ) 

Access to Non-Invasive Prenatal Testing (NIPT) will be as a second line screening tool for women at high or intermediate level of risk after cFTS. The NIPT test is not available through Medicare and women will have to fund this test themselves. For further information contact the RPA Genetic Counsellors ph 9515 5080 or Fetal Medicine Unit ph 9515 6042

 Resources

  Patient Brochure- Screening tests for your baby in early pregnancy- NSW Health:  Centre for Genetics Education 
  Patient Brochures- RPA Women and Babies including Screening for preterm pre-eclampsia, cFTS, NIPT, CVS 
  Patient Brochure- Prenatal testing booklet - NSW Health : Centre for Genetics Education
  RACGP - Genomics in general practice 
 RACGP - Reproductive carrier testing
 First Trimester Sceening Learning Module: NSW Centre For Genetics: On-line education module 
Search for Certified Operators to perform Nuchal Translucency - RANZCOG Nuchal Translucency: Ultrasound, education and monitoring program

Translated material regarding genetics, prenatal testing and pregnancy are located at the Multicultural Health Communication Service - NSW Health.

Revision of Thyroid Services in response to COVID -19 : Effective 30/3/2020
In order to minimise the number of visits and time spent in hopsital , all consultations will henceforth be provided by telecommunication only. 

Please refer to the following resources to guide clinical management : Referral Flowchart (below) and Sydney Healthpathways - Thyroid Disease in pregnancy 

For any clinical concerns, please contact Dr Ash Gargya or Julie Hetherington in the Endocrinology and Metabolism Clinic ph. 9515 7225.

pdf Thyroid Disease Guidelines and referral flowchart (390 KB) : Who to screen, Thyroid Function Test Reference ranges in pregnancy, referral criteria

pdf Antenatal Thyroid Clinic Referral Form (358 KB) (April 2020) 

 

Get Healthy in Pregnancy ( NSW Health) - Free telephone-based service to support all women about eat healthily, getting active and maintaining a healthy weight during pregnancy

  Eat For Health ( Australian Government) -  Healthy eating during pregnancy - Consumer brochure

Pregnancy and alcohol  (Australian Government)

 Tobacco smoking and pregnancy ( NSW Health) 

GBS screen should be collected at 34-36 week GP visit .It needs to be collected PRIOR to hospital review at 37 weeks.

The GBS screening LVS can be attended as a pdf patient self- collection (1.65 MB)

Identifying women who are at risk of having a baby with GBS enables treatment to be given intrapartum to prevent transmission of infection to the baby. Discussion about GBS should take place at around 35 weeks gestation so that women have received information about preventive treatment before they go into labour. 

• SLHD Breastfeeding Policy 
• NHMRC Infant Feeding Guidelines